After Heart Attack: High Dose Aspirin Still Commonly Prescribed

MedicalResearch.com Interview with:
Hurst M. Hall, MD and Sandeep Das, MD, MPH
Division of Cardiology
University of Texas Southwestern Medical Center
Dallas, TX

Medical Research: What are the main findings of the study?

Answer: Most patients treated for a heart attack in the United States during this study period were discharged home on 325 mg of aspirin a day.  This was true even among subgroups expected to be at high bleeding risk. In addition, there was tremendous variability in the proportional use of this higher dose aspirin across hospitals, suggesting a prominent local influence on prescribing patterns.

Medical Research: Were any of the findings unexpected?

Answer: While some high-dose aspirin use can be explained by PCI guidelines prior to 2012, patients managed without PCI were also commonly discharged on high-dose aspirin. We were also surprised to find that patients with in-hospital bleeding events and those discharged on concomitant warfarin therapy were more likely than not to be discharged on higher dose aspirin.

Medical Research: What should clinicians and patients take away from your report?

Answer: Use of high-dose aspirin should not be done reflexively in patients after a heart attack. This practice may expose patients to significant bleeding risk without offsetting benefit, especially in the subgroups described above.

Medical Research: What recommendations do you have for future research as a result of this study?

Answer: It would be helpful to incorporate discharge aspirin dose as a formal quality metric in practice guidelines.  Further studies would then be able to track our performance in this area.
Citation:
Contemporary Patterns of Discharge Aspirin Dosing After Acute Myocardial Infarction in the United States: Results From the National Cardiovascular Data Registry (NCDR)

Hurst M. Hall, James A. de Lemos, Jonathan R. Enriquez, Darren K. McGuire, S. Andrew Peng, Karen P. Alexander, Matthew T. Roe, Nihar Desai, Stephen D. Wiviott, and Sandeep R. Das

Circ Cardiovasc Qual Outcomes. 2014;CIRCOUTCOMES.113.000822published online before print August 12 2014, doi:10.1161/CIRCOUTCOMES.113.000822

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